Abstract / Summary
Objectives: Budesonide irrigation (BI) has emerged as an effective postoperative topical therapy for chronic rhinosinusitis (CRS), providing improved drug delivery compared with conventional intranasal corticosteroid sprays. However, evidence regarding its role as a maintenance strategy during the critical postoperative period remains limited. This study aimed to evaluate the clinical efficacy of BI compared with saline irrigation (SI) in patients with persistent symptoms following functional endoscopic sinus surgery (FESS) and to determine whether treatment effects differed according to CRS inflammatory endotypes. Methods: This retrospective cohort study included 121 patients with CRS who underwent FESS between 2021 and 2024. Patients with persistent symptoms 3 months post-operation were treated with either continued SI (n = 54) or BI (n = 67) for at least 6 months. Clinical outcomes included changes in SNOT-22 scores, modified Lund–Kennedy endoscopic scores (mLKS), olfactory function assessed by KVSS II, oral corticosteroid (CS) use, and disease control status. Subgroup analyses were conducted for eosinophilic CRS (ECRS) and non-eosinophilic CRS (NECRS). Results: The BI group showed significantly greater improvement in total SNOT-22 scores than the SI group (p < 0.0001), particularly in rhinological symptoms. Endoscopic outcomes also favored BI, with greater reductions in total mLKS and mucosal edema scores. These benefits were observed in both ECRS and NECRS, although objective endoscopic improvements were more pronounced in ECRS. Patients receiving BI required fewer courses of oral CS (18.42% vs. 52.38%, p = 0.01) and demonstrated better disease control (p = 0.03). However, no significant difference was observed in olfactory function. Conclusions: BI provides superior symptom improvement, better endoscopic healing, and reduced oral CS use compared with SI during postoperative CRS maintenance, supporting its use in both ECRS and non-ECRS subgroups.